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The OR of the Future

By Don Sadler

Trying to predict the future can be dangerous, especially when it comes to technology. There’s a long list of technology predictions that have failed to materialize, such as flying cars, nuclear-powered vacuum cleaners and mail delivered by rockets, to name a few.

However, recent advances in medical technology make it a little bit easier to start envisioning what the OR of the future might look like. These include advances in virtual reality (VR), augmented reality (AR), artificial intelligence (AI), machine learning (ML) and robotic assisted surgery devices (RASDs).

A Decade of Advances

“I think we’re going to see more technological advances in the OR over the next decade than we have seen in the last 100 years,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC. “Virtual reality and robotic surgery tools used for diagnosing disease in surgery or at the bedside will become part of our everyday lives.”

Taylor points to the mapping of the human genome as an example of the power of technology in health care. “This was completed in 2001 at a cost of nearly $3 billion. Today it could be done for as little as $1,000 and by 2022 it might be cheaper than a lab test,” he says.

Reducing hospital acquired infections (HAIs) is one of the many benefits of adopting new technology in the OR, Taylor adds.

“CDC statistics indicate that one out of every 25 surgical patients, or 300,000 patients a year, will contract an infection,” he says. “Technology can have a tremendous impact in reducing this number.”

According to Bejoy Daniel, senior industry analyst, transformational health with Frost & Sullivan, operating rooms are transforming into “technology-powered, infection-free, sleek surgical environments. The new-age OR will be able to utilize intelligent and efficient delivery options to improve the precision and predictability of the services offered.”

A report prepared by Frost & Sullivan, “Analysis of the US and EU5 Hospital Operating Room (OR) Products and Solutions Market, Forecast to 2022,” predicts that by 2022, between 35 percent and 45 percent of ORs around the world will have transitioned or be in the process of transitioning to become integrated ORs.

In an integrated OR, all of the technology and equipment are connected. “This includes, but isn’t limited to, patient information systems, medical records, audio, video, lighting and medical equipment,” explains Taylor.

“An integrated OR gives clinicians the ability to enable and control all functions of these devices from a single location using a touch screen or even voice activation,” Taylor adds.

Hybrid ORs take integrated ORs a step further, says Thomas Schneider, vice president of global product management, surgical workplaces, for Getinge.

“A hybrid OR is a combination of a surgical (sterile) environment with one or more imaging modalities,” Schneider explains.

“It goes beyond medical boundaries by combining a state-of the-art OR with an imaging system, such as angiography systems, CT scanners or MRI scanners,” Schneider adds. “Combining more than one imaging system with an OR turns the hybrid OR into a cutting-edge multi-modality hybrid suite.”

Trauma patient outcomes improve significantly in the hybrid OR, notes Schneider, since patient transport between departments and medical teams is reduced. Since the patient remains in the sterile OR, the risk of health care acquired infections is reduced.

“In addition, hybrid ORs allow for closer collaboration among specialists throughout the treatment chain,” Schneider adds, “especially between radiologists and surgeons.”

Robotic Adoption is Widespread

Many of the technological advances in the OR are being driven by the widespread adoption of RASDs, notes Daniel.

“RASDs have aided in the significant reduction of surgery-related complication rates from between 36 percent and 38 percent to between 12 percent and 15 percent,” he says.

Taylor adds that sales of robotic equipment are expected to nearly double in 2020 to $6.4 billion. “Robotics and VR will just become part of a clinician’s toolbox,” he says.

“Robotics are going to explode and be very different from what we’ve seen with current RASDs,” says Rafael Grossman, MD, FACS, a general and trauma surgeon who was one of the first surgeons to use Google Glass during surgery. “We will be able to perform minimally invasive surgeries in ways we’ve only dreamed about so far.”

Schneider acknowledges that while robotics is generally considered to be the technology with the greatest potential to change how surgery is done, key challenges remain.

“These include not only the substantial initial investment required, but also the high ongoing operational expenses involved,” he says.

“However, we are convinced that the adoption pace of robotic-assisted surgery will accelerate significantly within the next few years,” says Schneider. “We have seen many new RASD launches that will most likely take away significant market share from Intuitive Surgical’s da Vinci system, which currently holds almost a monopoly in minimally invasive robotic surgery.”

In addition, emerging technologies such as AI will take robotic surgery to the next level. “AI will lead to more automation, allowing us to perform robotic surgery with a smaller workforce,” says Schneider.

As for virtual reality, Grossman believes one of the most important uses of VR and AR in the OR is to train new surgeons. “Students can watch me perform a surgery in an adjacent room, instead of standing behind my back, and get the same perspective on the surgery that I have,” he says.

William K. Atkinson, Ph.D., MPH, MPA, FACHE, FACPE, a health care consultant and strategist, compares the use of VR and AR in training new surgeons to how the military uses these technologies in its training.

“For example, pilots learn how to fly aircraft and fire weapons using flight simulators before they do it for real,” says Atkinson. “In the same way, new surgeons can learn techniques virtually before they operate on patients. The technology is so realistic that it doesn’t feel much different when they perform surgeries for real the first time.”

The Role of Machine Learning and AI

According to Schneider, machine learning and artificial intelligence will have a huge role in the OR of the future.

“The automation of logistical processes that ML and AI allow ensures that the right medical device is available at the right time and in the right place,” Schneider says. “This automation also confirms that the right clinical decisions will occur in a highly stressful environment.”

“With ML and AI as decision support, the IT system can analyze millions of prior outcomes based on the current situation and suggest the most desired process and guidelines to the OR manager,” Schneider adds. “This will significantly reduce surgery delays and cancellations.”

AI can also eliminate cumbersome tasks during surgery, such as diming the lights when going to endoscopic surgery or providing the right table position at specific points during surgery.

“During surgery, AI can continuously analyze and combine information from surgical images recorded before and during surgery, suggesting different paths to the surgeon,” Schneider explains. “At the same time, the continuous analysis of the images taken during surgery will provide suggestions as to the next steps of the procedure.”

The Sky’s the Limit

Grossman believes that “the sky is the limit” when it comes to the OR of the future.

“The possibilities are only limited by our creativity and imagination,” he says.

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